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Maine rates for HCPCS 64612

Chemodnrvtj Musc Musc Innervated Facial Nrv Unil

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.55 / $136.55 / $156.27
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$851.40 / $890.68 / $890.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.99 / $156.05 / $193.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.41 / $152.25 / $228.54
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$194.12 / $228.37 / $342.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.18 / $202.07 / $295.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.38 / $177.79 / $303.61
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$851.40 / $851.40 / $890.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.55 / $156.27 / $222.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.61 / $180.02 / $277.48